Cognitive and Emotional Well-Being of Preschool Children Before and During the COVID-19 Pandemic

Key Points Question What is the association between exposure to the COVID-19 pandemic and preschool-aged children’s cognitive and emotional development? Findings In this cross-sectional study including data from the Ontario Birth Study, pandemic-exposed children had significantly higher problem solving and fine motor skills at 24 months of age but lower personal-social skills compared with nonexposed children. At 54 months of age, pandemic-exposed children had significantly higher vocabulary, visual memory, and overall cognitive performance compared with nonexposed children. Meaning These findings suggest that health care practitioners and educators may encounter a mix of pandemic-related outcomes among young children as they plan recovery efforts following the pandemic.

In the primary analyses, pandemic exposure was entered into the models as a binary variable.The pandemic exposure variable was coded as 0 = non-exposed and 1 = pandemicexposed, based on whether participants were assessed before or after March 11, 2020 (e.g., the date the WHO declared Covid-19 a global pandemic).Participants therefore had varying lengths of pandemic exposure at the date they were assessed (for example, a participant who was assessed on March 12, 2020, would have 1 day of exposure to the pandemic, whereas a participant who was assessed on March 11, 2021, would have one year of exposure to the pandemic).In order to see whether children's neurocognitive and socioemotional outcomes varied based on the length of time they were exposed to the pandemic, we conducted additional sensitivity analyses.

Sensitivity Analysis: Pandemic Duration
We included the length of time a participant was exposed to the pandemic (measured in days) as the predictor variable.The outcome variables were the ASQ-3 scores at 24 months and the NIH Toolbox cognitive tasks and Emotion Battery at 54 months.This analysis only included participants with pandemic exposure.

Sensitivity Analysis: Proportion of Pandemic Exposure
In this follow-up analysis, the proportion of time a child was exposed to the pandemic (measured by dividing the number of days they were exposed to the pandemic by their age in days at the time of the assessment) was included in the models as the predictor variable.Only participants with at least some pandemic exposure were included in analyses.

Sensitivity Analysis: Hierarchical Regression Models
To examine the unique contribution of pandemic duration and pandemic exposure on children's neurocognition and socioemotional development, a hierarchical multiple regression analysis was performed.In the first step of the analysis, the covariates were added.In the second step, pandemic duration (the length of exposure to the pandemic measured in days) was added to the model.In the third step, pandemic exposure as a binary variable (non-exposed = 0 and pandemic-exposed = 1) was added.
At 24 months, pandemic exposure, but not duration, was significantly and negatively associated with gross motor and social skills.Conversely, fine motor skills were significantly higher when pandemic duration, but not pandemic exposure, was included in the model.Problem solving skills was significantly higher when both pandemic duration and pandemic exposure were included in the model.At 54 months, pandemic duration was associated with higher Picture Sequence Memory and overall cognitive performance scores.The association between pandemic exposure versus non-exposure (reference category) with risk of neurodevelopmental difficulties ("typicallydeveloping" versus "at-risk" based on cut-off) using the ASQ-3 and MCHAT-R at 24 months.Participants who had neurodevelopmental diagnoses (N = 9) were excluded from analyses The association between pandemic exposure versus non-exposure (reference category) with neurodevelopment as a continuous score using the ASQ-3 at 24 months.Participants who had neurodevelopmental diagnoses (N = 9) were excluded from analyses

eTable 1 .
Association Between Pandemic Exposure vs Nonexposure With Risk of Neurodevelopmental Difficulties Using the ASQ-3 and MCHAT-R at 24 Months

Table 2 .
Association Between Pandemic Exposure vs Nonexposure With Neurodevelopment as a Continuous Score Using the ASQ-3 at 24 Months © 2023 Finegold KE et al.JAMA Network Open.e Association Between Pandemic Exposure vs Nonexposure With Age-Corrected Standard Scores for NIH Toolbox Cognitive Tasks and Age-and Sex-Corrected T-Scores From the Emotion Battery The association between pandemic exposure versus non-exposure (reference category) with age-corrected standard scores for NIH Toolbox cognitive tasks and age and sex-corrected T-scores from the Emotion Battery.Participants who had neurodevelopmental diagnoses (N = 18) were excluded from analyses.Association Between the Duration of Exposure to the Pandemic and ASQ-3 Scores at 24 Months All models were adjusted for covariates (e.g., gestational age, birth weight, total family income, maternal age, maternal race/ethnicity, maternal birth country, and maternal level of education) Association Between the Duration of Exposure to the Pandemic and NIH Toolbox Cognitive and Emotion Battery Scores at 54 Months The association between the duration of exposure to the pandemic (measured in days) and NIH Toolbox cognitive and Emotion Battery scores at 54 months All models were adjusted for covariates (e.g., gestational age, birth weight, total family income, maternal age, maternal race/ethnicity, maternal birth country, and maternal level of education) Association Between the Proportion of a Participant's Life Spent in the Pandemic and ASQ-3 Scores at 24 Months Association Between the Proportion of a Participant's Life Spent in the Pandemic and NIH Toolbox Cognitive Tasks and Emotion Battery Scores at 54 Months Association Between Pandemic Exposure Grouped as Bins and ASQ-3 Scores at 24 Months Association Between Pandemic Exposure Grouped in Bins and NIH Toolbox Cognitive and Emotion Battery Scores at 54 Months Summary of Hierarchical Regression Analysis for Pandemic Exposure Variables and ASQ-3 Scores at 24 Months Summary of Hierarchical Regression Analysis for Pandemic Exposure Variables and NIH Toolbox Cognitive Scores at 54 Months Summary of Hierarchical Regression Analysis for Pandemic Exposure Variables and NIH Emotion Battery Scores at 54 Months 1 Confidence Interval a Models adjusted for child sex, gestational age (in weeks), birth weight, total family income, maternal age, maternal race/ethnicity, maternal birth country, and maternal level of education.©2023FinegoldKEetal.JAMA Network Open.eTable 3. a Models adjusted for child sex, gestational age (in weeks), birth weight, total family income, maternal age, maternal race/ethnicity, maternal birth country, and maternal level of education.©2023FinegoldKEetal.JAMA Network Open.eTable 4. © 2023 Finegold KE et al.JAMA Network Open.eTable 5. © 2023 Finegold KE et al.JAMA Network Open.eTable 6. © 2023 Finegold KE et al.JAMA Network Open.eTable 7. © 2023 Finegold KE et al.JAMA Network Open.eTable 8. © 2023 Finegold KE et al.JAMA Network Open.eTable 9. eTable 10. © 2023 Finegold KE et al.JAMA Network Open.eTable 11. © 2023 Finegold KE et al.JAMA Network Open.eTable 12.